Paediatric Buruli ulcer in Australia

Abstract

Aim: This study describes an Australian cohort of paediatric Buruli ulcer (BU) patients and compares them with adult BU patients. Methods: Analysis of a prospective cohort of all BU cases managed at Barwon Health, Victoria, from 1 January 1998 to 31 May 2018 was performed. Children were defined as ≤15 years of age. Results: A total of 565 patients were included: 52 (9.2%) children, 289 (51.2%) adults aged 16-64 years and 224 (39.6%) adults aged ≥65 years. Among children, half were female and the median age was 8.0 years (interquartile range 4.8-12.3 years). Six (11.5%) cases were diagnosed from 2001 to 2006, 14 (26.9%) from 2007 to 2012 and 32 (61.5%) from 2013 to 2018. Compared to adults, children had a significantly higher proportion of non-ulcerative lesions (32.7%, P < 0.001) and a higher proportion of severe lesions (26.9%, P < 0.01). The median duration of symptoms prior to diagnosis was shorter for children compared with adults aged 16-64 years (42 vs. 56 days, P = 0.04). Children were significantly less likely to experience antibiotic complications (6.1%) compared with adults (20.6%, P < 0.001), but had a significantly higher rate of paradoxical reactions (38.8%) compared with adults aged 16-64 (19.2%) (P < 0.001). Paradoxical reactions in children occurred significantly earlier than in adults (median 17 vs. 56 days, P < 0.01). Cure rates were similarly high for children compared to adults treated with antibiotics alone or with antibiotics and surgery. Conclusions: Paediatric BU cases in Australia are increasing and represent an important but stable proportion of Australian BU cohorts. Compared with adults, there are significant differences in clinical presentation and treatment outcomes.

Environmental and behavioural factors associated with Mycobacterium ulcerans infection in the district of Lalo in Benin: A case-control study

“…Note that in Australia, some studies have shown a predominance of the disease in adult subjects (Yerramilli et al, 2017;Walker et al, 2019). This discrepancy between our study and that of Nigeria could be explained by differences between the study periods.…”

Complicated Mycobacterium ulcerans infection in a child in the Northern Territory

“…3 Optimal specimen collection includes two cotton swabs from beneath the undermined edges of the ulcer, or punch biopsies from edges of the lesion. 4 Due to significant necrosis from the production of mycolactone, lesions are often polymicrobial. Treatment of M. ulcerans should be prioritised, although secondary bacterial infection has been postulated to delay wound healing.…”

“…Early clinical suspicion ensures appropriate samples are collected, including fresh tissue for microbiological and PCR investigations, as well as formalin‐fixed for histopathology, although unfortunately diagnostic delays persist in non‐endemic areas 3 . Optimal specimen collection includes two cotton swabs from beneath the undermined edges of the ulcer, or punch biopsies from edges of the lesion 4 …”

“…Paradoxical reactions are thought to arise from reduction in mycolactone‐induced immune inhibition with the commencement of antimicrobial treatment and killing of the mycobacteria 5 . An Australian case series showed paradoxical reactions occur more frequently in children (38.8%) than in adults (19.2%), and earlier in the treatment course (median 17 and 53 days, respectively) 4 . Diagnosis of paradoxical reaction can be clinical, with progression of the lesion despite adequate antimicrobial therapy, or histopathological, with intense inflammatory infiltrates 4,7 ; this case primarily had clinical deterioration which responded well to methylprednisolone.…”

Buruli ulcer – A neglected tropical disease in the Barwon region of Victoria, Australia: An emerging public health threat with local and national ramifications

“…In this well-resourced highincome (HI) setting, early diagnosis followed by appropriate combination of antibiotic therapy and the judicious use of adjunctive plastic surgery has a near 100% treatment success rate. 8,9 The emerging public health threat BU is known as Bairnsdale ulcer or Daintree ulcer in Australia. 8 The disease is highly focal, with endemic and non-endemic areas separated by only a few kilometres.…”